Adherence to the American Diabetes Association retinal screening guidelines for population with diabetes in the United States

ABSTRACT

Purpose: (1) To assess long-term adherence to American Diabetes Association guideline-recommended retinal screening among population with diabetes in the United States. (2) To determine factors associated with long-term adherence to routine eye screening exams.

Methods: A retrospective cohort study was conducted in adult patients with diabetes identified from January 2009 to December 2010. Patients were followed until disenrollment, death, or study end date (December 2013). A patient was defined as adherent when having at least one exam in each 12-month period if there was evidence of retinopathy, or at least one exam in each 24-month period if there was no evidence of retinopathy. Multivariate logistic regressions were used to investigate patient demographics and other baseline characteristics associated with adherence to guidelines.

Results: A total of 204,073 patients were identified; the mean age (SD) was 61 (13) years and 48% were female. Overall, 71.1% were adherent to the retinal screening guidelines during a median of 4.8 years of follow-up including 27.7% who received an eye exam every year. Patient socioeconomic status (younger age, black race, lower income/education), less comorbidity, insulin use, higher specialist copayment plans, and proxies for poor patient behavior (lower adherence to the oral hypoglycemic agents, less diabetes education, hemoglobin A1C >9%) were associated with nonadherence to routine eye screening exams.

Conclusion: During nearly 5 years of follow-up, 28.9% of patients with diabetes were nonadherent to the retinal screening guidelines. Future research should focus on the development of interventions to address modifiable factors associated with nonadherence.

KEYWORDS:

• diabetes
• NCQA/HEDIS
• ophthalmology
• practice guidelines/patterns
• quality of care
• retinal screening

Supplemental data

Supplemental data for this article can be accessed here.

Declaration of interest

Drs. An and Cheetham, Ms. Niu received research support from Genentech. Dr. Turpcu and Ms. Yamina Rajput are employees of Genentech.

Prior presentation

The study findings were presented the HMO Research Network 21st Annual Conference, Long Beach, CA, March 11–13, 2015. This submission has not been published anywhere previously and that it is not simultaneously being considered for any other publication.

Additional information

Funding

This study was funded by a contractual agreement between Kaiser Permanente Southern California/Western University of Health Sciences and Genentech.